Navegando por Palavras-chave "transplante de fígado"

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    Avaliação da influência da esteatose do enxerto no resultado do transplante de fígado
    (Universidade Federal de São Paulo (UNIFESP), 2014-12-17) Cezar, Leandro Dias [UNIFESP]; Linhares, Marcelo Moura Linhares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Steatosis is frequently present in liver grafts, and it is usually admitted that small grade (<30%) of macrosteatosis is safe to transplant and is not advisable to use graft with severe (>=60%) macrosteatosis. However there is no consensus about the real cut off for extent of macrosteatosis and on the risk of microsteatosis. The aim of this study is to evaluate the steatosis influence on transplant outcome in a large unicentric cohort. Methods: We performed a retrospective analysis of a prospectively maintained database in a single center. Two thousand seven hundred and six patients (2.706) were transplanted from December 3, 1984 to December 31, 2010. Among these grafts, 1132 had steatosis (924 macro, 782 micro, 458 macro and micro). Graft biopsies were available in 98% of the cases. Donor and recipient data and surgical factors were analyzed. The end-points were primary dysfunction, delayed graft function (aspartate aminotransferase level >2.000 and TP<30%), 3-month, 1-year and 5-year survival. A multivariable analysis and logistic regression were performed to indentify the risk factors associated with the outcome. Results: The presence of microsteatosis or macrosteatosis at any percentage is a risk factor for graft dysfunction or primary nonfunction (OR: 1.41 and 1.39; P= 0.01 and 0.02 respectively). The 3-month and 1-year graft survival is only affected by macrosteatosis more than 30% (OR: 1,94, P= 0.002 and OR: 1.41, p= 0.02 respectively). According to the grade of macrosteatosis, the 1 year graft survival was 81% for <30% macrosteatosis, 73% for 30-50% macrosteatosis, 67% for 50-60% macrosteatosis, 58% for >=60% macrosteatosis; the 5 year graft survival was 67% for <30% macrosteatosis, 66% for 30-50% macrosteatosis, 44% for 50-60% macrosteatosis, 38% for >=60% macrosteatosis. Conclusion: The presence of graft steatosis, (macro or micro) does affect the initial graft function. Only Macrosteatosis more than 30% does affect graft survival. With more than 50% macrosteatosis risk of graft loss overexceeds 50% and becomes prohibitive.
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    Avaliação da transecção do fígado no transplante hepático pediátrico
    (Universidade Federal de São Paulo (UNIFESP), 2013-12-20) Benini, Barbara Burza [UNIFESP]; Gonzalez, Adriano Miziara Gonzalez [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Liver transplantation is an effective technique in the treatment of end-stage liver disease. Purpose: The aim of this study was to evaluate the impact of hepatic transection, advanced surgical techique able to tailor size to generate two grafts to from a single donor. Methods: A retrospective study between January 2000 and September 2013, reviewing 91 pediatric patients who underwent 96 liver transplants from deceased donors. Patients were distributed into two groups: whole organ (WO, n 39) and transected liver grafts (TLG, n 57). The folowing was evaluated etiology, anthrophometric parameters (age, weight, height, z score weight/age and height/age), meld or peld, previous surgeries, transfusion of blood components, 1-year survival rate, preoperative laboratory testing, from the second and seventh postoperative days, lactate during surgery, postoperative complications, duration of surgery, duration of cold and warm ischemia, types of biliary reconstruction and laboratory testing of the donor. Results and discussion: The anthropometric values showed significant differences (p<0.05) between the groups. The average age was 124.7 months in the WO and 33.6 months in the TLG group (P<0.0001), while the weight was 28.0 kg and 7.4 kg, respectively (P<0.0001). The analysis of z score weight/age showed that the TLG had greater acute and chronic malnutrition, probably due to the etiology of liver disease, present from birth in patients as young. Red blood transfusion was higher in the group TLG (P<0.0006) due to the cut surface of the graft, emphasizing the use and improvement of hemostatic techniques. Despite differences between the groups, clinical or surgical complications were similar, showing that liver transection injury didn’t change the results of transplantation. Conclusion: There was no impact on liver function, graft or 1-year patient survival after liver transection. Transection liver transplantation is an effective method as an alternative to liver pediatric transplantation. Among the factors related to death, lactate and rate of blood transfusion were statistically relevant.